Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2024
ReviewThe nature of the response to airway management incident reports in high income countries: A scoping review.
Adverse events associated with failed airway management may have catastrophic consequences, and despite many advances in knowledge, guidelines and equipment, airway incidents and patient harm continue to occur. Patient safety incident reporting systems have been established to facilitate a reduction in incidents. However, it has been found that corrective actions are inadequate and successful safety improvements scarce. ⋯ These included 23 full-text articles, 78 conference abstracts and 10 national guidelines addressing a range of airway initiatives across anaesthesia, intensive care and emergency medicine. While findings and recommendations from airway incident analyses are commonly published, there is a gap in the literature regarding the resulting system changes to reduce the number and severity of adverse airway events. Airway safety management mainly focuses on Safety-I events and thereby does not consider Safety-II principles, potentially missing out on all the information available from situations where airway management went well.
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Anaesth Intensive Care · Sep 2024
A pre and post interventional audit of an 'apple juice on arrival' protocol to reduce excessive clear fluid fasting times in paediatric patients.
Many studies have reported prolonged fasting times in children, associated with negative metabolic and behavioural outcomes. We felt that although our paediatric preoperative clear fluid fasting guideline was only for 2 hours, prolonged fasting still occurred for some patients. We conducted an audit of paediatric fasting times, before and after introducing a new protocol of 'apple juice on arrival', in which, on arrival to the children's ward, all children received 3 ml/kg of apple juice. ⋯ Clear fluid fasting times reduced from an average of 9.9 hours pre-intervention to 3.5 hours post intervention (P < 0.01). In addition, mean preoperative blood sugar levels increased from 4.9 mmol/L (pre-intervention group) to 5.6 mmol/L in the post-intervention group (P < 0.001). The implementation of an apple juice on arrival protocol appeared to be an effective method to reduce clear fluid fasting times in children in our institution.
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Anaesth Intensive Care · Sep 2024
A single-centre retrospective study of the utility of routine chest X-ray post intrathoracic drain removal in cardiothoracic surgical patients.
Routine chest X-ray (CXR) post intrathoracic drain removal in cardiac surgical patients is common practice to identify the presence of a pneumothorax following drain removal. Such pneumothoraces occur infrequently and rarely require intervention. We investigated the utility of routine CXR post drain removal and hypothesised that the practice is unnecessary and a possible area for significant cost saving. ⋯ The potential cost saved by omitting routine CXR post drain removal was estimated to be approximately A$7750 per year. This study did not detect any clinically significant pneumothoraces requiring intervention. It also suggests that routine CXR post drain removal does not provide any clinical benefit and indicates that current practice should be reviewed.
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Anaesth Intensive Care · Sep 2024
ReviewRoutine cognitive screening for older people undergoing major elective surgery: Benefits, risks and costs.
Cognitive impairment and older age are major risk factors for postoperative delirium. Professional societies have advocated preoperative screening to identify at-risk individuals for implementation of interventions, which have moderate effectiveness in preventing delirium. However, it remains unclear from the guidelines whether screening should be completed routinely for all older individuals or targeted, and also which specific screening tool is preferred. ⋯ We also performed a cost-benefit analysis of routine screening (versus no screening). Furthermore, we summarised the sensitivities and specificities of commonly used screening tools and reviewed evolving screening tools that may have an increasing role in future practice. We concluded that routine screening is useful and appears to be cost-effective for reducing postoperative delirium, with a cost-benefit ratio of 2.89 (adjusted ratio of 2.34), and has additional advantages over other approaches such as targeted screening or routine intervention.
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Anaesth Intensive Care · Sep 2024
Variations of nitrous oxide procurement per public hospital bed between Australian states and territories: A cross-sectional analysis.
We aimed to identify variations in nitrous oxide (N2O) procurement between Australian states and territories per public hospital bed by undertaking a cross-sectional analysis of N2O procurement data for all Australian public hospitals from 1 January 2017 to 30 June 2022. Data were obtained from state and territory departments of health. All Australian public hospitals across six states and two territories were included. ⋯ CO2e emissions from N2O purchase varied more than threefold per public hospital bed between different states/territories (0.47-1.48 CO2e tonnes per hospital bed). There were significant variations in N2O procurement between Australian states and territories when adjusted for public hospital bed numbers. Further analysis of this variation to determine cause and to guide mitigation interventions is therefore warranted.